1.
Create a context "Let's be realistic," says
Dr Sotile, "you're a medical family." That means
facing facts and accepting that a marriage with
a physician comes with relentlessly difficult
circumstances and 60-plus working hours a week.

2.
Be humble Even though your circumstances are
exceptional, says Dr Sotile, "You can't be an
exception to the rules that apply to all couples."

3.
Take a leap of faith All couples report multiple
periods of rocky times, notes Dr Sotile. "Becoming
disillusioned is part of the journey of marriage,"
he says. It's essential that physicians make the
decision to slow down and drop back to fundamentals.
Don't lose faith and remember that little things
can make the biggest difference.

4.
Honour and cherish Dr Sotile urges you to
remember you married an exceptional high-achiever
("doctors aren't attracted to knuckleheads").
Honour them whether they're a neurosurgeon or
a stay-at-home-parent. And don't forget to hold
hands and be nice. "Everybody needs a honeypie,"
stresses Dr Sotile.

5.
Leave work at work It's natural for doctors
to carry the burden of their stressful days back
home. But what you've got to remember is that
many of the qualities that make you a great doc
 multitasking, hyper-vigilance, perfectionism,
competitiveness  don't work at home.

6.
Don't "wait until" Marriages ending after
the 30th anniversary have tripled in the last
decade. The last generation of physicians fell
prey to the "wait until" lifestyle, but Dr Sotile
urges today's docs: "Fix your marriage now!"

"I wish that we could stop this
D-I-V-O-R-C-E," sang Tammy Wynette plaintively back
in 1968. An increasing number of unhappy physicians
living through a break-up are singing the same tune.

All marriages are a lot of work
 high levels of stress about money, kids and careers
come part and parcel. Throw a doctor in the mix and
long hours, job-related stress and often unrealistic
expectations can mean instant big trouble almost before
the honeymoon's over.

Divorce rates in Canada peaked
at 44% in 1987 and have since fallen back to the current
rate of 37% but are slowly on the rise. Despite their
extra-large stress burden, there are no reliable statistics
to suggest that rates among physicians differ.

"The fact that MDs don't have astronomical
divorce rates," says Dr Wayne Sotile, PhD, a clinical
psychologist in Winston-Salem, NC, "attests that they're
extraordinary people, with a work ethic comparable to
none." Dr Sotile and his wife Mary, have written numerous
articles and books on the subject and in 30 years of
practice have counted more than 3,000 physicians as
clients.

Over the years they've discovered
that medical marriages don't break down for the reason
you'd assume. "More than the hours worked, what determines
levels of stress is the physician's mood when they get
home," says Dr Sotile emphatically. "Are they too tired
to participate in family life? Are they irritated or
worried about work?" He says many doctors make the fatal
mistake of "wearing the sack cloth and ashes all the
time," but not showing compassion to their own families.
"They'll say, 'I'm dealing with life or death issues
here  of course I can't go to Joe's baseball game.'"

MD
DIVORCE STATS
A growing number of studies have delved into physician
divorce. There are wide variations depending on sex
and speciality. According to a 1997 US study, psychiatrists
have the highest rate at around 50%; surgeons are next
at 33%; the profession as a whole has a divorce rate
of 29%. The study found an elevated divorce rate among
female physicians and those who married while still
in med school.

A 2003 study by Dr Gail Robinson
of the Toronto General Hospital into stresses faced
by women doctors found that "rates of successful suicide
and divorce are much higher" than in the general public.

Dr Sotile's clinical experience
bears this out. He doesn't blame the women though, he
blames their families."The burnout and divorce rate
for women MDs is higher and it only has to do with them
getting slaughtered by their young husbands," he says.
"Their families are always busting their chops about
what they're missing." But ironically he notes that
the 'feminization of the profession' has led to an increase
in similar work/life conflict for male physicians, who
now expect a better balance.

ANGRY
YOUNG MEN
Dr Sotile says easily the most angry and disgruntled
group he's encountered is young men married to physicians.
"This was a real surprise to us," he says. "We're still
dealing with old horrid wiring about sex roles." The
message he hears over and over from these young men
is "if my masculinity's not being honoured, I get angry."
Take this angry post on the website MedicalSpouse.com
from Matt, a SAHD (stay-at-home dad) married to a pediatrician:
"So, DW [dear wife] is now off on her third conference.
The boys and I get to stay at home. She's 'roughing
it' in the Colorado Mtns. She had to go and get the
required CME credits, but please.... she's going on
a sleigh ride, pulled by draft horses to a secluded
cabin in the resort, fed a magnificent meal, FREE DRINKS,
and hot chocolate.... how romantic." Wives on the site
express these sentiments too but are much more resigned.

Just as surprising, says Dr Sotile,
is that many women docs have the same outmoded expectations.
He describes the case of one of his physician clients
whose husband got downsized. They decided he'd stay
home with the kids, but she confessed to Dr Sotile that
she felt ashamed her husband didn't go out to work:
"My daddy would have found a job flipping burgers,"
she said.

DOCS
MARRIED TO DOCS
A 1999 survey of US docs found 22% of male physicians
were married to another working physician. A 2002 study
looking at dual physician marriages found they have
a relatively low divorce rate of 11%. "They're a happily
married cohort," says Dr Sotile. "They're more compassionate
about the passion for the career  they understand
the calling because they share it."

Nevertheless, every medical marriage
has to have a stress absorber. Usually this role is
filled by the non-physician in the marriage. "One MD
might have to choose not to take their first choice
speciality," he says. "This is tough  they'll
get no support from their families, so these marriages
can start off with strain." On the upside, two-physician
marriages tend to learn to be more flexible, and Dr
Sotile found docs married to docs tend to work slightly
shorter hours.